Study Says Prevention Efforts Won't Cut Health Costs

A popular idea for fixing the healthcare system that just about everyone seems to agree on is increasing government's role in disease prevention. Sounds good, but Louise Russell a researcher professor at Rutgers University says it is not going to cut costs, and it is not going to make us healthier. She points out that we already do a lot more prevention than other countries, but we are not healthier. Her research findings don't question the benefits of a healthy lifestyle and the effectiveness of many preventive measures. The problem as she sees it is that when preventive testing becomes too widespread, or heavy investments are made in monitoring people with chromic conditions, the rewards often fail to match the costs.

The Congressional Budget Office in a recent report concluded that greater use of preventive care would at best generate modest reductions in cost over 10 years, and might eventually result in increases. One reason cost savings are hard to acheive, according to Russell, is that much of the money spent on disease prevention goes for people who aren't going to get sick anyway.

Medicare has conducted seven pilot programs over the past ten years to test whether preventive measures save money. The largest of these included about 200,000 patients with chronic conditions, mostly diabetes and congestive heart failure. Nurses contacted patients to make sure they were following doctor's instructions and taking their meds. They sent out literature packets about caring for patient's diseases and guided them toward communit health classes. Overall these efforts didn't reduce these patients rate of acute care hospitalizations, hospital readmissions, emergency room visits, or deaths. In short, these preventive actions were not able to lower patient's Medicare payments by an amount equal to cost of the prevention services. In spite of results like this, private health insurers are placing bets that prevention can lower their costs. United Health Group estimates that Medicare could save almost $25 billion over 10 years on patients with congestive heart failure if it identifed high risk patients early and counseled them to stay healthier.

Many will argue that focusing on savings is the wrong way to think about prevention. Healthcare is a good, and we don't purchase goods to save money. When a new antibiotic comes out, we don't react by first asking if it saves money.